How Should We Teach Lumbar Manipulation? A Consensus Study

Background Spinal manipulation is an effective intervention for low back pain, yet there is little consistency in how this skill is taught. Objectives The purpose of this study was to identify what educators and clinicians believe are important characteristics of the patient and operator position prior to side-lying lumbar manipulation and the patient position and operator motion during the manipulative thrust. Design A multi-disciplinary correspondence-based Delphi method Methods Three rounds of questionnaires were sent to physical therapists, osteopaths and chiropractors. Consensus was established in Round 3 if at least 75 % of respondents identified a characteristic as very important/extremely important on a 5-point Likert scale. Results 265 educators and clinicians completed the three rounds of questioning. There was consensus that localization to target segment, patient comfort, table height, and log rolling the patient towards the operator are important characteristics of patient position during the preparatory phase. During the manipulation phase, respondents agreed that it is important to maintain localization to the segment and rotate the patient’s pelvis and lumbar spine. For the operator characteristics, consensus was reached for the following items; moving up and over the patient, maintaining contact using forearms, and close contact between the operator and patient (preparatory phase); generating force through the body and legs, dropping the body downwards, maintaining localization, and providing a high-velocity and low-amplitude thrust (manipulation phase). Conclusions This Delphi study successfully identified key characteristics of patient position and operator position and motion for effective delivery of side-lying lumbar spine manipulations